Modifying Dynafit TLT-6 for Morton’s Neuroma


Post by WildSnow.com blogger | December 12, 2016      
Punchomatic.

Punchomatic. I pre-heat the ring press mandrel (hidden inside boot), and using an infrared thermometer I keep the temperature of the Grilamid under 240 degrees. This kind of punch is best with Grilamid and PU plastics, Pebax is difficult. The chunk of steel under the ring places most of the ring pressure on the edge of the sole area so the punch doesn’t get blocked by the edges of the ring. Multiple punches are required.

A boot fitting client has Morton’s Neuroma. We think probably caused by too many years in pointy toe ski touring boots compressing their metatarsal bones like they’re skiing in a machinist’s vise. Whatever the cause, this is serious. Morton’s can shut down a ski touring career, not to mention placing you in a desk chair the rest of your life.

(Morton’s is a thickening of tissue around a nerve that routes between metatarsal bones in the ball of your foot. It feels like you’ve got a rock in your boot, and it hurts. Problem: if unchecked Morton’s feeds on itself and gets progressively worse. Morton’s Neuroma.

Morton’s treatment general outline, in order of priority:
– Modify footwear (including footpads adhered to feet, boot widening, and footbed mods).
– Anti inflammatory measures (NSAID and ice).
– Physical therapy (stretching and massage).
– Lifestyle adjustments (quit working on concrete floors, or ski less?).
– Injections and other medical provider interventions.
– Surgery.

This blog post: how we modify ski boots for the condition.

First step was to do a mega-punch on the TLT-6 toebox.

First step was to do a mega-punch on the TLT-6 toebox. Widest part of foot was located on both sides. Punching began there and was extended forward and back. I’m not sure how much the widening process is shown in this photo, but we enlarged the last by around 7 millimeters along with customizing to the shape of the foot. The boot now fits with virtually no squeeze on the metatarsal, quite comfortable though downhill performance is slightly compromised. You can see the customized shape at the toe of the liner.

Gill cuts were made before a liner remold. I make the slits in the bottom, top and sides of the metatarsal area.

Gill cuts were made before a liner remold. I make the slits in the bottom, top and sides of the metatarsal area. After final fitting, the cuts are taped over while the foot is in the liner with an extra sock, so the cuts stay spread out under the tape.

Last thing for now.

Last thing for now. Locate neuroma by palpating with fingers under footbed while it’s held on the bottom of foot. Mark location, then do a bit of grinding to form a pressure reduction pocket. This is done with care, in stages. Most footbeds are quite hard, it may be necessary to swap in a gel footbed (cheap ones available at pharmacy can be very effective). It may also be advisable to use a wider footbed. Check that your molding and modding does not create a “boat” shaped footbed that compresses the foot. The “mets” need to spread out.

Experimentation is key with this. Morton’s is pain, so it’s easy to test different fits until something provides relief. While doing so, it’s best for the boot fitting client to go off their NSAID pain killers so their feet are sensitive to footwear customization. This is especially helpful when you palpate under the footbed with their foot on top, to located the exact point you skive under the footbed.

Once the boot and footbed are modified, it’s time to pursue cortisone and perhaps more if the problem continues. Modifying all other footwear is also recommended.



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Comments

18 Responses to “Modifying Dynafit TLT-6 for Morton’s Neuroma”

  1. Gordon King December 12th, 2016 11:27 am

    I’m putting new boots on a year-old pair of skis and Dynafit Radical 2.0 and I’ve got a question regarding the “kiss gap” on Radical 2.0 bindings. After reading ther blog post on this I want to make sure I’m reading it right – there should be just a tiny sliver of space between the heel piece of the Radicals and my boot? Thanks for everyone’s help!

  2. DavidB December 12th, 2016 5:03 pm

    My wife has two Mortons Neuromas on the same foot next to each other. If it was one they can be operated on a removed. It’s not pleasant surgery but with two they just say live with it.

    She takes no pain relief, is in constant pain but refuses to live her life on pain killers. It’s matter of getting mind over matter but she does struggle.

    Thanks for this post Lou.

  3. Claude December 12th, 2016 8:13 pm

    Hi Lou, I have Hallux Valgus on the outside (little toe) on my both feet since a few years. I bought a punch like yours but I would like to see more picture of yours to confirm my technique if you have any more. Like why have you put a steel bar under the boot? Finally, do you have a good link for my specific problem ? Thanks, I love that post!

  4. See December 12th, 2016 9:35 pm

    Message to young skiers who’s feet hurt: it’s not supposed to be that way. I have wide feet, and I endured many painful years and probably sustained injury because I wore shoes/boots that were supposedly my size but were too narrow. In my experience, most shops will sell you what they have in stock (usually the lowest common denominator sizes). If it hurts, it doesn’t fit.

  5. Bruno Schull December 13th, 2016 12:31 am

    Hi. I have Morton’s Neuroma in one both feet, because I have very large bunions on the inside of my feet, which is genetic, and because I spent so many years wearing narrow, tight bike racing shoes. I had surgery on one foot, and it took longer than I hoped to recover, but two or three years later I am doing fine, and call it a success. It’s just another occasional problem that flares up, and that I have to manage, like all the other aches and pains of old age. Here are some things that worked for me:

    1) Find footbeds that works for you, and use them religiously. I get new ones for my everyday shoes every two years, and rotate the old ones through my ski boots, climbing boots, running shoes, and so on. These may be, but do not need to be, custom medical devices. They should feel good on your feet. You know best. Don’t let any doctor/expert tell you they know better than you. See this article about the (non)science of foot beds:

    http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all&_r=0

    I finally found somebody who is both a professional orthopedist and an amazing craftsman. My foot beds are full length, with arch support, metatarsal support, cushion under the front of the foot, and a pressure relief window below the neuroma. Yours might be very different.

    2) Wear Birkenstock sandals around the house. Those wide cook foot beds are so comfortable. As a New Yorker, it was particularly galling to me to wear Birkenstocks, symbol of hippies around the world (for the record, I love hippies). I have not been able to bring myself to wear them outside the house.

    3) CorrectToes spacers really work, especially for flare ups.
    https://www.correcttoes.com/
    I refuse to wear the special socks, however.

    4) Accept that you will almost certainly compromise some performance in ski boots or climbing boots or shoes. For ski boots, I have to buy bigger than I would otherwise, just to get the space in front (perhaps Lou’s boot fitting skill would make this unnecessary, but I remain unconvinced). For alpine climbing and hiking boots, it’s the same; I have to buy big boots. For rock climbing shoes, my solution is to climb everything with big, wide approach shoes. That’s nice, because it puts a natural limit on what I can climb as I get older, and when I fail I have a built in excuse–It’s the shoes!

    But seriously, being able to walk is more important that skiing or climbing. I know some people might not agree. So do what you have to do.

  6. Rod Georgiu December 13th, 2016 8:16 am

    Instead of creating a hole, you need to put a pad a little back from where the pain is.
    The pad will spread the toes apart.

    Since the neuroma probably started with narrow shoes, wearing wide shoes is the way to deal with it.
    Steroid injections are a problem as they will destroy the fat pad and eventually make it worse. Supposedly only three injections in your lifetime.

    No pain killers, they just mask the pain.

    I had Morton’s neuroma for a few years and with shoe or ski bit modifications it went away entirely.

    Surgery is successful half the time. Th ere are some blogs that talk about this surgery, and there are some horror stories.

    Btw, making the boots wider in the mid foot area, I’m my experience, did not affect the control while skiing.

  7. Greg Louie December 13th, 2016 8:55 am

    Instead of the steel bar, I use strips of finishing wood with a semi-circle routed into the surface to match the ring diameter – you can then skip the masking tape. A footbed with slightly more arch support often helps, mold it with less weight and consider making a manual detent in the metatarsal ridge after it cools (and adding some posting material around the area that gets the pressure). As Rod mentions, a metatarsal bump just to the rear of the affected area helps a lot of people – this can also be added manually by the fitter.

  8. Lou Dawson 2 December 13th, 2016 9:15 am

    Rod, it seems for some folks just doing a window in the footbed is best, while others like the pad behind, and some both. The key is to experiment while the neuroma is sensitive.

    Greg, I like the idea of using wood for fittings, I’ll give it a try. I’ve been using various spacer methods, while I prepare to build some fittings or even a different system. We do have a boot expander as well, which sometimes works quite a bit better than the ring press if the expander mandrels are heated in the convection oven first, but it does sometimes draw down the shell on top of the toes unless it’s set up exactly right. Widening the boot with the ring press seems to result in less lowering of the shell over the toes.

  9. See December 13th, 2016 8:27 pm

    Wood expander mandrels aren’t such a heat sink as metal.

  10. See December 14th, 2016 7:16 am

    I made some wood mandrels based on my own feet that make fitting new boots a lot easier, but figuring out the shapes, mechanism and procedure was a lot of work.

  11. Lou Dawson 2 December 14th, 2016 8:15 am

    I had a visitor here who said he’d made a mechanical boot expander out of a wooden woodworker’s clamp, customized to his feet. I might do the same as a fun blogpost. Lou

  12. See December 14th, 2016 1:35 pm

    Sounds interesting. I’ve been using a nut and bolt to tighten two plastic wedges against a tapered wood block inside the boot, but I’m not sure it works any better than the method I used before— tracing my foot on a piece of plywood, cutting it out and jamming it in the boot.

  13. See December 14th, 2016 2:55 pm

    Lest anyone read my earlier comments and end up trashing their boots, I should mention that the process is a lot more complicated than I made it sound, and I have a pretty well equipped shop (fancy heat gun, infrared thermometer, etc.). Practice on some dumpster boots and remember that not all plastic is the same.

  14. Dorth December 15th, 2016 8:01 am

    I would love to see some more boot fitting articles on shell manipulation

    Boot fitters obvs have their place but I think it would be helpful for a lot of folks to see what goes in determining and the process of placing punch or grind. Or a look at the “tools of the trade”

    Seems like it’s almost treated as a dark art – or something the general public doesn’t have much insight into

  15. James December 15th, 2016 2:14 pm

    I second Dorth’s request for a detailed boot mod article going into what can and can’t be done, tools of the trade (pro and amateur), and tips.
    I’ve personally found boot fitters (in southern Germany and Austria) don’t really listen and just suggest using their (in my view crude) stretching rig for general stretching and none of them have even heard of a targeted boot punch or heaven forbid a grind!, plus they don’t really want to discuss methods and outcomes either. If we had a bit more info we could be better armed to negotiate and work with them.
    Either that of build our own rigs and sort out our own and our friends boots ourselves.
    I would love to find an enlightened boot fitter and pay them, but everyone I ask has no idea where this can be found. I have been to numerous shops to try to find one (and paid for stretches which didn’t even widen the boot as well).
    Rant over, sorry got a bit carried away, it’s a sore point!

  16. Lou Dawson 2 December 15th, 2016 4:49 pm

    James, we’ve done a lot of boot fitting articles over the years that’ll help.

    https://www.wildsnow.com/category/boot-fitting/

    But now that I see the interest I’ll do more articles. Both Lisa, myself and our son Louie have our Masterfit certification, though we do not work at bootfitting as a profession. I’m pretty well tooled up here, but lack a few of the items you’d find in an active fitting shop.

    Lou

  17. Wookie1974 December 20th, 2016 4:58 am

    James – I live in Munich, and I’ve ranted about the lack of really good bootfitters here myself. I do it myself these days. I’d spent thousands on crappy bootfitting that didn’t work, so I figured that wrecking a pair of boots learning wouldn’t be so bad.
    I never did wreck a pair of boots though. Lou’s site has been a great help.

    If you’re still not convinced, your best bet is to go to an orhtopedic shoe-maker. Most of these guys will build a skiboot for you in Europe, and can even give you a perscription for it, so that the German or Austrian state medical systems will pay at least part of the cost.

    And Lou – any info you can get on sourcing or making tools and equipment for DIYers like me (in Europe) is greatly appreciated. I want to buy or build a boot press – and if there is enough interest, I can manufacture a few at the MakerSpace where I am a member.

  18. Jason Hughes May 9th, 2018 8:40 am

    Major respect!

    If you’re looking for something to help with your pain, check out my blog: https://www.thesewisefeet.com.

    I talk a lot about footwear and foot injuries.

    Love the mods! I’ve never seen anything like it! 😆





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